Should we administer rectal anti-inflammatory drugs in all ERCPs in order to prevent pancreatitis? At least, it does not harm!

Acute pancreatitis is the most common complication of endoscopic retrograde cholangio-pancreatography (ERCP). The sensitivity of the pancreas, which may respond with such violence to the slightest pressure exerted at the entrance to its main duct in the papilla of Vater, is even philosophically surprising. In fact, each touch on the papilla increases the potential for pancreatitis development. The initial stimulus resulting in obstruction of pancreatic secretion may be the edema caused by the catheter's physical contact, the thermal effect of sphincterotomy, or the overdistension induced by the injected contrast. The triggering fact is followed by a release of inflammatory cytokines, which induce changes in pancreatic microcirculation.